National Statement on Ethical Conduct in Human Research

Transcription

1 National Statement on Ethical Conduct in Human Research Developed jointly by National Health and Medical Research Council Australian Research Council Australian Vice-Chancellors Committee

2 Endorsed March 2007 Reprinted October 2007 Australian Government 2007 Paper-based publications This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth available from the Attorney-General's Department. Requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney General's Department, Robert Garran Offices, National Circuit, Canberra, ACT, 2600 or posted at: ISBN Print: Australian Government 2007 Electronic documents This work is copyright. You may download, display, print and reproduce this material in unaltered form only (retaining this notice) for your personal, non-commercial use or use within your organisation. Apart from any use as permitted under the Copyright Act 1968, all other rights are reserved. Requests for further authorisation should be directed to the Commonwealth Copyright Administration, Attorney General's Department, Robert Garran Offices, National Circuit, Canberra, ACT, 2600 or posted at: Online: To obtain details regarding NHMRC publications contact: Phone: Toll Free NHMRC ( ) or call Internet:

3 CONTENTS Contents The National Statement : A User Guide 1 Preamble 3 Purpose, scope and limits of this document 7 Section 1 Values and principles of ethical conduct 11 Section 2 Themes in research ethics: risk and benefit, consent 15 Chapter 2.1 Risk and benefit 15 Chapter 2.2 General requirements for consent 19 Chapter 2.3 Qualifying or waiving conditions for consent 23 Section 3 Ethical considerations specific to research methods or fields 25 Chapter 3.1 Qualitative methods 25 Chapter 3.2 Databanks 29 Chapter 3.3 Interventions and therapies, including clinical and non-clinical trials, and innovations 33 Chapter 3.4 Human tissue samples 39 Chapter 3.5 Human genetics 41 Chapter 3.6 Human stem cells 47 Section 4 Ethical consideration specific to participants 51 Chapter 4.1 Women who are pregnant and the human foetus 51 Chapter 4.2 Children and young people 55 Chapter 4.3 People in dependent or unequal relationships 59 Chapter 4.4 Chapter 4.5 People highly dependent on medical care who may be unable to give consent 61 People with a cognitive impairment, an intellectual disability, or a mental illness 65 Chapter 4.6 People who may be involved in illegal activities 67 national statement on ethical conduct in human research iii

4 CONTENTS Chapter 4.7 Aboriginal and Torres Strait Islander Peoples 69 Chapter 4.8 People in other countries 73 Section 5 Processes of research governance and ethical review 77 Chapter 5.1 Institutional responsibilities 77 Chapter 5.2 Responsibilities of HRECs, other ethical review bodies, and researchers 83 Chapter 5.3 Minimising duplication of ethical review 87 Chapter 5.4 Conflicts of interest 89 Chapter 5.5 Monitoring approved research 91 Chapter 5.6 Handling complaints 93 Chapter 5.7 Accountability 95 Appendix: Process Report 97 Glossary 99 Index 103 iv national statement on ethical conduct in human research

5 the national statement: A user guide THE NATIONAL STATEMENT: A USER GUIDE This National Statement on Ethical Conduct in Human Research ( National Statement ) is intended for use by: any researcher conducting research with human participants; any member of an ethical review body reviewing that research; those involved in research governance; and potential research participants. This brief guide describes the structure of the document and suggests how each of these groups might use it. Note that review body refers both to Human Research Ethics Committees (HRECs) and to non-hrec review bodies. The Preamble sets out the historical context of the National Statement. This is followed by a brief explanation of its purpose, scope and limits. The document then has five sections, with multiple chapters in Sections 2 to 5. Section 1: Values and principles of ethical conduct sets out values and principles that apply to all human research. It is essential that researchers and review bodies consider these values and principles and be satisfied that the research proposal addresses and reflects them. Section 2: Themes in research ethics: risk and benefit, consent discusses the concept of risk in research and the role of participants consent themes in all human research and is again essential for all users. Chapter 2.1 will help researchers and reviewers to understand and describe the level of risk involved in the planned research, and how to minimise, justify and manage that risk, and (with reference to Chapter 5.1) what level of ethical review is suitable. Chapters 2.2 and 2.3 will help to identify the information that needs to be disclosed to participants. It will help researchers to draft information for participants and plan the consent process (or develop a proposal for waiver of consent). And it will help reviewers to assess the suitability of the proposed consent process. All of Section 2 will help participants understand what information they are entitled to receive, and what their participation in research will characteristically involve. Section 3: Ethical considerations specific to research methods or fields will help researchers and reviewers to identify ethical matters specific to the research methods proposed. Section 4: Ethical considerations specific to participants will help researchers and reviewers to identify ethical matters relating to specific categories of research participants. Participants in these categories will also find this Section valuable. Section 5: Processes of research governance and ethical review will help those involved in research governance to understand their responsibilities for research ethics and ethical review and monitoring of human research, and provides criteria for their accountability. Chapter 5.2 will help researchers and reviewers to identify their responsibilities in relation to the ethical review of research. national statement on ethical conduct in human research 1

6 the national statement: a useres guide This National Statement does not exhaust the ethical discussion of human research. Even a single research field covers a multitude of different situations about which the National Statement will not always offer specific guidance, or to which its application may be uncertain. Where other guidelines and codes of practice in particular research fields are consistent with the National Statement, researchers and members of ethical review bodies should draw on them when necessary to clarify researchers ethical obligations in particular contexts. 2 national statement on ethical conduct in human research

7 Preamble Preamble Ethical background All human interaction, including the interaction involved in human research, has ethical dimensions. However, ethical conduct is more than simply doing the right thing. It involves acting in the right spirit, out of an abiding respect and concern for one s fellow creatures. This National Statement on ethical conduct in human research is therefore oriented to something more fundamental than ethical do s and don ts namely, an ethos that should permeate the way those engaged in human research approach all that they do in their research. Human research is research conducted with or about people, or their data or tissue. It has contributed enormously to human good. Much human research carries little risk and in Australia the vast majority of human research has been carried out in a safe and ethically responsible manner. But human research can involve significant risks and it is possible for things to go wrong. Sometimes risks are realised despite the best of intentions and care in planning and practice. Sometimes they are realised because of technical error or ethical insensitivity, neglect or disregard. On rare occasions the practice of research has even involved the deliberate and appalling violation of human beings notoriously, the Second World War experiments in detention and concentration camps. This range of possibilities can give rise to important and sometimes difficult ethical questions about research participation. Two considerations give further weight to those questions. First, research participants may enter into a relationship with researchers whom they may not know but need to trust. This trust adds to the ethical responsibility borne by those in whom it is placed. Secondly, many who contribute as participants in human research do so altruistically, for the common good, without thought of recompense for their time and effort. This underscores the importance of protecting research participants. Since earliest times, human societies have pondered the nature of ethics and its requirements and have sought illumination on ethical questions in the writings of philosophers, novelists, poets and sages, in the teaching of religions, and in everyday individual thinking. Reflection on the ethical dimensions of medical research, in particular, has a long history, reaching back to classical Greece and beyond. Practitioners of human research in many other fields have also long reflected upon the ethical questions raised by what they do. There has, however, been increased attention to ethical reflection about human research since the Second World War. The judgment of the Nuremberg military tribunal included ten principles about permissible medical experiments, since referred to as the Nuremberg Code. Discussion of these principles led the World Medical Assembly in 1964 to adopt what came to be known as the Helsinki Declaration, revised several times since then. The various international human rights instruments that have also emerged since the Second World War emphasise the importance of protecting human beings in many spheres of community life. During this period, written ethical guidelines have also been generated in many areas of research practice as an expression of professional responsibility. But what is the justification for ethical research guidelines as extensive as this National Statement, and for its wide-reaching practical authority? The National Statement has been extended to address many issues not discussed in the previous version, or discussed in less detail. This is in response to requests for clearer national statement on ethical conduct in human research 3

8 Preamble guidance for those conducting research and those involved in its ethical review. At the same time, without compromising the protection of participants, the revised National Statement provides for greater flexibility in the practice of ethical review, depending on the type and area of research and the degree of risk involved. Research often involves public interaction between people that serves a public good. There is, therefore, a public responsibility for seeing that these interactions are ethically acceptable to the Australian community. That responsibility is acknowledged and given effect in the wide-reaching authority of this National Statement, which sets out national standards for the ethical design, review and conduct of human research. Its content reflects the outcome of wide consultation with Australian communities who participate in, design, conduct, fund, manage and publish human research. Research governance The National Statement should be seen in the broader context of overall governance of research. It not only provides guidelines for researchers, Human Research Ethics Committees (HRECs) and others conducting ethical review of research, but also emphasises institutions responsibilities for the quality, safety and ethical acceptability of research that they sponsor or permit to be carried out under their auspices. Responsibility for the ethical design, review and conduct of human research is in fact exercised at many levels, by: researchers (and where relevant their supervisors); HRECs and others conducting ethical review of research; institutions that set up the processes of ethical review, and whose employees, resources and facilities are involved in research; funding organizations; agencies that set standards; and governments. While the processes of ethical review are important in this field, individual researchers and the institutions within which they work hold primary responsibility for seeing that their research is ethically acceptable. In addition to this National Statement, the Australian code for the responsible conduct of research (the Research Code ) has an essential role in promoting good research governance. The Research Code sets down the broad principles of responsible and accountable research practice, and identifies the responsibilities of institutions and researchers in areas such as data and record management, publication of findings, authorship, conflict of interest, supervision of students and research trainees, and the handling of allegations of research misconduct. Authors of this National Statement This National Statement has been jointly developed by the National Health and Medical Research Council (NHMRC), the Australian Research Council (ARC) and the Australian Vice-Chancellors Committee (AVCC). This joint undertaking reflects a widely shared conviction that there is a need for ethical guidelines that are genuinely applicable to all human research; and it gives expression to the shared responsibility for ethically good research described above. The National Health and Medical Research Council Act 1992 (NHMRC Act) establishes the NHMRC as a statutory body and sets out its functions, powers and obligations. Section 10(1) of the Act requires the Chief Executive Officer to issue human research guidelines precisely as developed by the Australian Health Ethics Committee (AHEC) and provided to the CEO by the Council. AHEC is established by the NHMRC Act as a Principal Committee of the NHMRC. All the guidelines in this National Statement that are applicable to the conduct of medical research involving humans are issued by the NHMRC in fulfilment of this statutory obligation. 1 This is the proposed revision of the Joint NHMRC/ AVCC Statement and Guidelines on Research Practice (1997). 4 national statement on ethical conduct in human research

9 Preamble The Australian Research Council Act 2001 (ARC Act) establishes the ARC to provide the responsible Minister with advice and recommendations about research, including which research programs should receive financial assistance. The functions of the ARC also include administering the regimes of financial assistance for research and providing for the funding of research programs. The Australian Vice-Chancellors Committee (AVCC) is the council of Australia s university vice-chancellors (or presidents). Its purpose is to advance higher education through voluntary, cooperative and coordinated action, and to serve the best interests of Australia s universities and, through them, the nation. The AVCC acts as a consultative and advisory body for all university affairs, making submissions to public inquiries of interest to the university sector, and preparing statements on major issues. national statement on ethical conduct in human research 5

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11 purpose, scope and limits of this document Purpose, Scope and Limits of this Document Purpose The purpose of this National Statement is to promote ethically good human research. Fulfilment of this purpose requires that participants be accorded the respect and protection that is due to them. It also involves the fostering of research that is of benefit to the community. The National Statement is therefore designed to clarify the responsibilities of: institutions and researchers for the ethical design, conduct and dissemination of results of human research; and review bodies in the ethical review of research. The National Statement will help them to meet their responsibilities: to identify issues of ethics that arise in the design, review and conduct of human research, to deliberate about those ethical issues, and to justify decisions about them. Use of this National Statement This National Statement must be used to inform the design, ethical review and conduct of human research that is funded by, or takes place under the auspices of, any of the bodies that have developed this National Statement (NHMRC, ARC, AVCC). In addition, the National Statement sets national standards for use by any individual, institution or organisation conducting human research. This includes human research undertaken by governments, industry, private individuals, organisations, or networks of organisations. What is research? There is no generally agreed definition of research; however, it is widely understood to include at least investigation undertaken to gain knowledge and understanding or to train researchers. The British Research Assessment Exercise (RAE) definition of research is somewhat wider: Research includes work of direct relevance to the needs of commerce, industry, and to the public and voluntary sectors; scholarship; the invention and generation of ideas, images, performances, artefacts including design, where these lead to new or substantially improved insights; and the use of existing knowledge in experimental development to produce new or substantially improved materials, devices, products and processes, including design and construction. It excludes routine testing and routine analysis of materials, components and processes such as for the maintenance of national standards, as distinct from the development of new analytical techniques. It also excludes the development of teaching materials that do not embody original research. 2 2 Higher Education Funding Council for England, Scottish Higher Education Funding Council, Higher Education Funding Council for Wales, & Department for Employment and Learning Northern Ireland (2005) RAE 2008: Guidance to Panels, p.28. At ac.uk/pubs/2005/01/rae0105.doc, accessed 27th October 2006 national statement on ethical conduct in human research 7

12 purpose, scope and limits of this document To enable comparative assessment of academic activity, this definition sought to include the widest range of creative and experimental activities. Many items in the definition are uncontentious, but there may be disagreement about some for example, the invention and generation of new images, performances, artefacts where these lead to new or substantially improved insights since this could count poetry, painting and performing arts as research. For the purposes of this National Statement, two further questions are more important than any definition of research: What is human research? When and by what means does human research, or other activities such as quality assurance or improvement, or clinical audit, need ethical review? (See When does quality assurance in health care require independent ethical review? NHMRC 2003.) What is human research? Human research is conducted with or about people, or their data or tissue. Human participation in research is therefore to be understood broadly, to include the involvement of human beings through: taking part in surveys, interviews or focus groups; undergoing psychological, physiological or medical testing or treatment; being observed by researchers; researchers having access to their personal documents or other materials; the collection and use of their body organs, tissues or fluids (eg skin, blood, urine, saliva, hair, bones, tumour and other biopsy specimens) or their exhaled breath; access to their information (in individually identifiable, re-identifiable or non-identifiable form) as part of an existing published or unpublished source or database. The term participants is therefore used very broadly in this National Statement to include those who may not even know they are the subjects of research; for example, where the need for their consent for the use of their tissue or data has been waived by a Human Research Ethics Committee (HREC). In addition, the conduct of human research often has an impact on the lives of others who are not participants. When this impact is reasonably foreseeable, it may raise ethical questions for researchers and for those ethically reviewing research. When is ethical review needed? Institutions are responsible for establishing procedures for the ethical review of human research. That review can be undertaken at various levels, according to the degree of risk involved in the research (see Section 2: Themes in research ethics: risk and benefit, consent, and Chapter 5.2: Responsibilities of HRECs, other ethical review bodies, and researchers). Research with more than a low level of risk (as defined in paragraph 2.1.6, page 18) must be reviewed by an HREC. Research involving no more than low risk may be reviewed under other processes described in paragraphs to (page 79). Institutions may also determine that some human research is exempt from ethical review (see paragraphs and , page 79). A judgement that a human research proposal meets the requirements of this National Statement and is ethically acceptable must be made before research can begin and before full funding for the proposal is released. Ethics and law in human research Human research is governed by Australian law that establishes rights for participants and imposes general and specific responsibilities on researchers and institutions. Australian common law obligations arise from the relationships between institutions, researchers and participants. Contractual arrangements may impose obligations on research funders and institutions. 8 national statement on ethical conduct in human research

13 purpose, scope and limits of this document This National Statement focuses on the ethical aspects of the design, review and conduct of human research. Research ethics is only part of an institution s responsibilities for research governance. Compliance with legal obligations (statutory or otherwise) forms another part, which is not within the scope of the National Statement. Some human research is subject to specific statutory regulation, at Commonwealth and State and Territory levels. The National Statement identifies some specific Commonwealth legislation that refers to the National Statement. The National Statement does not identify State and Territory laws that may be relevant to human research, such as those relating to use of information held by state or territory authorities, use of human tissues, guardianship, and illegal and unprofessional conduct. The responsibilities set out in this National Statement are intended to be consistent with the international human rights instruments that Australia has ratified. It is the responsibility of institutions and researchers to be aware of both general and specific legal requirements, wherever relevant. national statement on ethical conduct in human research 9

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15 Section 1: Values and Principles of ethical conduct Section 1: Values and Principles of Ethical Conduct Introduction The relationship between researchers and research participants is the ground on which human research is conducted. The values set out in this section respect for human beings, research merit and integrity, justice, and beneficence help to shape that relationship as one of trust, mutual responsibility and ethical equality. For this reason, the National Statement speaks of research participants rather than subjects. While these values have a long history, they are not the only values that could inform a document of this kind. Others include altruism, contributing to societal or community goals, and respect for cultural diversity, along with the values that inform Values and Ethics: Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Research (NHMRC 2003). However, the values of respect, research merit and integrity, justice, and beneficence have become prominent in the ethics of human research in the past six decades, and they provide a substantial and flexible framework for principles to guide the design, review and conduct of such research. This National Statement is organised around these values, and the principles set out in paragraphs 1.1 to 1.13 give them practical expression. Among these values, respect is central. It involves recognising that each human being has value in himself or herself, and that this value must inform all interaction between people. Such respect includes recognising the value of human autonomy the capacity to determine one s own life and make one s own decisions. But respect goes further than this. It also involves providing for the protection of those with diminished or no autonomy, as well as empowering them where possible and protecting and helping people wherever it would be wrong not to do so. Reference to these values throughout the National Statement serves as a constant reminder that, at all stages, human research requires ethical reflection that is informed by them. The order in which they are considered reflects the order in which ethical considerations commonly arise in human research. Research merit and integrity are discussed first. Unless proposed research has merit, and the researchers who are to carry out the research have integrity, the involvement of human participants in the research cannot be ethically justifiable. At a profound level, justice involves a regard for the human sameness that each person shares with every other. Human beings have a deep need to be treated in accordance with such justice, which includes distributive justice and procedural justice. In the research context, distributive justice will be expressed in the fair distribution of the benefits and burdens of research, and procedural justice in fair treatment in the recruitment of participants and the review of research. While benefit to humankind is an important result of research, it also matters that benefits of research are achieved through just means, are distributed fairly, and involve no unjust burdens. Researchers exercise beneficence in several ways: in assessing and taking account of the risks of harm and the potential benefits of research to participants and to the wider community; in being sensitive to the welfare and interests of people involved in their research; and in reflecting on the social and cultural implications of their work. national statement on ethical conduct in human research 11

16 Section 1: Values and Principles of ethical conduct Respect for human beings is the common thread through all the discussions of ethical values. Turning to it as the final value is a reminder that it draws together all of the ethical deliberation that has preceded it. The design, review and conduct of research must reflect each of these values. Guidelines Research merit and integrity 1.1 Research that has merit is: (d) (e) (f) justifiable by its potential benefit, which may include its contribution to knowledge and understanding, to improved social welfare and individual wellbeing, and to the skill and expertise of researchers. What constitutes potential benefit and whether it justifies research may sometimes require consultation with the relevant communities; designed or developed using methods appropriate for achieving the aims of the proposal; based on a thorough study of the current literature, as well as previous studies. This does not exclude the possibility of novel research for which there is little or no literature available, or research requiring a quick response to an unforeseen situation; designed to ensure that respect for the participants is not compromised by the aims of the research, by the way it is carried out, or by the results; conducted or supervised by persons or teams with experience, qualifications and competence that are appropriate for the research; and conducted using facilities and resources appropriate for the research. 1.2 Where prior peer review has judged that a project has research merit, the question of its research merit is no longer subject to the judgement of those ethically reviewing the research. 1.3 Research that is conducted with integrity is carried out by researchers with a commitment to: (d) Justice searching for knowledge and understanding; following recognised principles of research conduct; conducting research honestly; and disseminating and communicating results, whether favourable or unfavourable, in ways that permit scrutiny and contribute to public knowledge and understanding. 1.4 In research that is just: (d) (e) (f) taking into account the scope and objectives of the proposed research, the selection, exclusion and inclusion of categories of research participants is fair, and is accurately described in the results of the research; the process of recruiting participants is fair; there is no unfair burden of participation in research on particular groups; there is fair distribution of the benefits of participation in research; there is no exploitation of participants in the conduct of research; and there is fair access to the benefits of research. 1.5 Research outcomes should be made accessible to research participants in a way that is timely and clear. 12 national statement on ethical conduct in human research

17 Section 1: Values and Principles of ethical conduct Beneficence 1.6 The likely benefit of the research must justify any risks of harm or discomfort to participants. The likely benefit may be to the participants, to the wider community, or to both. 1.7 Researchers are responsible for: designing the research to minimise the risks of harm or discomfort to participants; clarifying for participants the potential benefits and risks of the research; and the welfare of the participants in the research context. 1.8 Where there are no likely benefits to participants, the risk to participants should be lower than would be ethically acceptable where there are such likely benefits. 1.9 Where the risks to participants are no longer justified by the potential benefits of the research, the research must be suspended to allow time to consider whether it should be discontinued or at least modified. This decision may require consultation between researchers, participants, the relevant ethical review body, and the institution. The review body must be notified promptly of such suspension, and of any decisions following it (see paragraphs to 5.5.9, page 91 92). Respect 1.10 Respect for human beings is a recognition of their intrinsic value. In human research, this recognition includes abiding by the values of research merit and integrity, justice and beneficence. Respect also requires having due regard for the welfare, beliefs, perceptions, customs and cultural heritage, both individual and collective, of those involved in research Researchers and their institutions should respect the privacy, confidentiality and cultural sensitivities of the participants and, where relevant, of their communities. Any specific agreements made with the participants or the community should be fulfilled Respect for human beings involves giving due scope, throughout the research process, to the capacity of human beings to make their own decisions Where participants are unable to make their own decisions or have diminished capacity to do so, respect for them involves empowering them where possible and providing for their protection as necessary. Application of these values and principles Research, like everyday life, often generates ethical dilemmas in which it may be impossible to find agreement on what is right or wrong. In such circumstances, it is important that all those involved in research and its review bring a heightened ethical awareness to their thinking and decision-making. The National Statement is intended to contribute to the development of such awareness. This National Statement does not exhaust the ethical discussion of human research. There are, for example, many other specialised ethical guidelines and codes of practice for specific areas of research. Where these are consistent with this National Statement, they should be used to supplement it when this is necessary for the ethical review of a research proposal. These ethical guidelines are not simply a set of rules. Their application should not be mechanical. It always requires, from each individual, deliberation on the values and principles, exercise of judgement, and an appreciation of context. national statement on ethical conduct in human research 13

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19 Section 2: themes in research ethics: risk and benefit, consent Chapter 2.1 : Risk and Benefit Section 2: Themes in Research Ethics: Risk and Benefit, Consent Two themes must always be considered in human research: the risks and benefits of research, and participants consent. For this reason, the two themes are brought together in this section, before discussion in the following sections of ethical considerations specific to different research methods and categories of participants. chapter 2.1: Risk and benefit Introduction The conduct of research in Australia is characterised by high ethical and scientific standards, and the dangers to participants have been few. The continued promotion of ethically good human research the purpose of this National Statement will help to maintain these standards. Application of the values in Section 1, in particular the value of beneficence, requires that risks of harm to research participants, and to others, be assessed. Research will be ethically acceptable only if its potential benefits justify those risks. While this chapter provides guidance on the assessment of risk, such assessment inevitably involves the exercise of judgment. What is risk? A risk is a potential for harm, discomfort or inconvenience (discussed below). It involves: the likelihood that a harm (or discomfort or inconvenience) will occur; and the severity of the harm, including its consequences. Assessment of risk Assessment of risks involves: identifying any risks; gauging their probability and severity; assessing the extent to which they can be minimised; determining whether they are justified by the potential benefits of the research; and determining how they can be managed. Assessment of risks engages: researchers, who need to identify, gauge, minimise and manage any risks involved in their project; institutions, in deciding the appropriate level of ethical review for research projects; Human Ethics Research Committees (HRECs) and other ethical review bodies (see paragraph 5.1.7, page 78), in reviewing research proposals and making judgements on whether risks are justified by potential benefits; and participants perceptions of risks and benefits. These perceptions are a factor to be considered by review bodies in deciding whether the risks are justified by the benefits. national statement on ethical conduct in human research 15

20 Section 2: themes in research ethics: risk and benefit, consent Chapter 2.1 : Risk and Benefit Harm, discomfort and inconvenience Research may lead to harms, discomforts and/or inconveniences for participants and/or others. No list of harms can be exhaustive, but one helpful classification identifies the following kinds of potential harms in research 3 : physical harms: including injury, illness, pain; psychological harms: including feelings of worthlessness, distress, guilt, anger or fear related, for example, to disclosure of sensitive or embarrassing information, or learning about a genetic possibility of developing an untreatable disease; devaluation of personal worth: including being humiliated, manipulated or in other ways treated disrespectfully or unjustly; social harms: including damage to social networks or relationships with others; discrimination in access to benefits, services, employment or insurance; social stigmatisation; and findings of previously unknown paternity status; economic harms: including the imposition of direct or indirect costs on participants; legal harms: including discovery and prosecution of criminal conduct. Less serious than harm is discomfort, which can involve body and/or mind. Discomforts include, for example, minor side-effects of medication, the discomforts related to measuring blood pressure, and anxiety induced by an interview. Where a person s reactions exceed discomfort and become distress, they should be viewed as harms. Less serious again is inconvenience. Examples of inconvenience may include filling in a form, participating in a street survey, or giving up time to participate in research. 3 Adapted from National Bioethics Advisory Commission, Ethical and Policy Issues in Research Involving Human Participants, Bethesda, 2001 pp Examples of risks to non-participants include the risk of distress for a participant s family member identified with a serious genetic disorder, the possible effects of a biography on family or friends, or infectious disease risks to the community. Some social research may carry wider social or economic risks; for example, research in a small community into attitudes to specific subpopulations may lead to unfair discrimination or have effects on social cohesion, property values, or business investment. Harms that may arise from research misconduct or fraud, and harms to members of research teams from other forms of misconduct (for example, harassment or bullying) are addressed primarily in the Australian code for the responsible conduct of research. These forms of misconduct may, of course, also lead to potential harms to participants. Low risk and negligible risk research The expression low risk research describes research in which the only foreseeable risk is one of discomfort. Research in which the risk for participants is more serious than discomfort is not low risk. The expression negligible risk research describes research in which there is no foreseeable risk of harm or discomfort; and any foreseeable risk is no more than inconvenience. Requirements for the ethical review of low risk research and negligible risk research are set out in paragraphs to , page 79. Gauging risk Gauging risk involves taking into account: the kinds of harm, discomfort or inconvenience that may occur; the likelihood of these occurring; and the severity of any harm that may occur. These judgements should be based on the available evidence. The evidence may be quantitative or qualitative. In either case, the process needs to be transparent and defensible. 16 national statement on ethical conduct in human research